Question

Formulate a nursing care plan for the preoperative and postoperative care of a child with myelomeningocele.

Answer 1

Myelomeningocele or Spina bifida is the protrusion of the spinal cord usually at the lumbar or sacral region.

Pre op :Anxiety, bowel and bladder incontinence, risk for injury

Post op:Infection,Pain,Stress,Ineffective coping

	Pre op	Post op
Nursing diagnosis	Impaired urinary elimination related to neurogenic bladder as evidenced inability to control urine	Risk for infection related to surgery as evidenced by incision and dressing
Assessment	Subjective Unable to control urine Have no sensation Objective Incontinence Wet underwear or pants Frequent changing of diapers by parents	Subjective : Complaining of pain Pain score Objective facial grimace Verbalization
Outcome	child will be able to control bladder	infection control practice are followed
Nursing intervention and rationale	Assess the urine for it color ,quantity to rule out any infection Administer medication as per order to enhance stopping incontinence Crede's manoeuvre or catheterization  to empty the bladder intermittently Encourage parents to use water proof clothes to prevent skin damage Health educate the parents regarding the care and treatment options,surgeries ,this enables the parents to take decision Maintain intake and output chart to assess and prevent any fluid loss	Follow strict asepsis in the procedure to prevent infection Administer medication as per order to prevent growth of microorganisms Follow hand washing, the first line of infection control practices Follow strict aseptic techniques duting dressing
Evaluation	the child able to perform its daily activity without discomfort	the child is infection free and recovers faster